Elwood YMCA

1620 E Main St
765-552-9808
Summer Day Camp
Come to the YMCA and enjoy a summer of fun filled
activities!
We will provide sports clinics, field trips, games,
crafts, swimming and lots of learning!






Registration Fee (due at time of sign-up): $20.00. This fee will help with the cost of the field trips and child will
receive a camp bag!
Childs Name ___________________________ DOB_____________
Parent Name__________________________________________________________________
Address______________________________________________________________________
Home Phone _____________________________ Cell Phone __________________________
Email Address ______________________Work Phone _____________________________
Emergency Contact Phone______________________________________________________
List anyone that will be picking up this child
_________________________________________________________________________________________
Please list any medical concerns or allergies
_________________________________________________________________________________________
*If child is walking or riding bike from Day Camp, a permission note from the parent/guardian must be provided. I release the
Elwood YMCA and the YMCA of Madison County, Inc. and any individuals associated with the YMCA from all claims or damages that may arise from my participation. I
verify that I am physically able to participate. This release shall apply to my heirs and personal representatives. If I sign this release for a minor or another family
member, I also agree to indemnify the YMCA for any claim they may assert. I have read this form and understand the expectations for the program(s) for which I have
registered.
Parent/Guardian Name__________________________________________________
Parent/Guardian Signature_______________________________________________ Date_____________
When: June 9
th
-July 25
th
Cost: $70/week-Members : $80/week-Non-Members Time:7:30am-5:30pm
(One week Break: June30
th
-July4
th
!) (Payments due by MONDAY each week!) (Mon.-Fri.)

**Schedule attached is subject to change due to weather conditions**
**Ages 5-12
**Lunch will be provided Mon.-Thurs., weather permitting. Fridays each child will need to bring a lunch. (If
there is a chance for bad weather please pack a lunch just in case.)
**On pool days, remember to send appropriate swimming attire and towels. Snacks are provided, but
concessions are available.